Evaluation of Parents Under Pressure™

Topics: Substance misuse

What works to help parents with drug or alcohol problems improve their parenting skills

Not all children whose parents misuse alcohol or drugs are at risk of harm, but parents who drink or use substances can find it particularly challenging to take care of their children.

We delivered Parents Under Pressure™ (PUP) to support mums and dads who are on a drug or alcohol treatment programme. It aims to teach them parenting skills and improve their relationship with their children.

We carried out two evaluations so we could find out more about the needs of the families who took part in PUP and the impact PUP had on their lives.

Our findings suggest that parents facing challenges including substance misuse can make positive changes with the right support.

An evaluation of Parents Under Pressure: a parenting programme for mothers and fathers who misuse substances.
Authors: Vicki Hollis, Richard Cotmore, Helen Fisher, Paul Harnett and Sharon Dawe.

Parents Under Pressure: a programme for families with parental substance misuse. An evaluation of impact, process and cost effectiveness (RCT).
Authors: Jane Barlow, Sukhdev Sembi, Stavros Petrou, Helen Parsons, Sharon Dawe and Paul Harnett.

Published: 2018

Background on our two evaluations

We commissioned the University of Warwick to carry out a multicentre randomised controlled trial (RCT) of PUP across seven of the 11 sites that were delivering the service. This helped us find out if parents who took part in PUP experienced more positive changes than a group of parents who didn’t take part in PUP, but received the usual treatment for their drug and alcohol problems (depending on what was available in their local area).

We explored the changes they experienced until six months after the programme finished, asked parents what they thought of the programme and looked at its cost-effectiveness.

We also conducted our own service evaluation of PUP based on analysis of the practice measures that were used by our practitioners during the programme. This included a larger sample of parents across all 11 sites and was designed to complement the RCT by focussing on how change occurs during the programme and what factors affect that change.

The RCT included the parents of children up to 2 and a half years whilst the service evaluation included the parents of children up to 5 years of age.

Key findings from our two evaluations

The parents enrolled in PUP often experienced other difficulties alongside substance misuse. This included:

  • domestic abuse;
  • financial problems;
  • relationship issues; and
  • mental health problems.

By the end of PUP, children whose parents had taken part were at less risk of abuse.

  • PUP significantly reduced the risk of child abuse for almost one third of the parents who took part in the programme. Those who received treatment as usual showed an increased risk of child abuse over time.
  • The service evaluation showed that the number of children on a child protection plan reduced and the number of children who were not involved with children’s services almost doubled.
  • However there was also an increase in the number of children who were no longer living with their parents by the end of PUP. This may be because PUP helps professionals gain a more informed assessment of the family’s needs, helping to better protect the child.

PUP helped parents to manage their emotions.

  • By the end of PUP, parents’ overall psychological wellbeing had improved. The RCT found sustained improvements in parents’ levels of depression and overall emotional wellbeing 6 months after the programme ended.
  • Parents with clinically significant levels of depression, anxiety and/or stress saw the greatest improvements in their emotional wellbeing.
  • Parents who took part in PUP said they felt more able to use mindfulness strategies as part of their parenting practice.

Parents made significant improvements in other areas too.

  • The RCT found that parents who took part in PUP were more able to regulate their emotions and identify problems.
  • Parents made the most significant improvements in the first half of the programme, and the RCT showed that changes were sustained 6 months after PUP finished.
  • The interviews carried out with parents for the RCT highlighted that the relationship between parent and practitioner was critical to parents’ capacity to change.

It was harder to identify what changed for the children whose parents took part in PUP because of the small numbers involved and the short duration of the follow-up.

  • However parents in the service evaluation reported significant positive changes in their child’s social and emotional wellbeing between the start and the end of the programme.

The parents who were most likely to complete the programme were:

  • those who had less family support; and
  • those who had already had children removed from their care.

These parents may have been more motivated to engage with the programme as they may have felt they had more to gain from it.

The interviews with practitioners for the RCT found:

  • Practitioners valued the PUP programme, which they felt was distinctive and offered a level of detail and flexibility not found in other parenting programmes.
  • Practitioners highlighted the importance of ongoing training and clinical supervision.

Quotes from parents who took part in the RCT

"I think I trusted my PUP worker more than anything.”
“Before I even started the course I’d like shout a lot. Now I don’t shout at all really. It’s the mindful thinking part of it. It’s useful. I don’t get so anxious all the time.”


Please cite as:

Hollis, V. et al (2018) An evaluation of Parents Under Pressure™; a parenting programme for mothers and fathers who misuse drugs and alcohol. London: NSPCC.

Barlow, J. et al (2018) Parents Under Pressure™: report of an RCT. London: NSPCC.